Non-Alcoholic Fatty Liver Disease (NAFLD)

The liver is an abdominal organ tucked under the lower right ribs. It serves many vital functions including filtering out toxins, producing a wide variety of substances needed by the body, catching infectious agents that come in from the blood flow out of the intestine, and handling chemical waste products made by the body.

Sometimes fat cells get deposited into the liver. This can happen because of too much alcohol use, but that is not the only time it happens. When it is not due to alcohol, it is called non-alcoholic fatty liver disease (NAFLD). The fat cells may just exist inside the liver, or they may cause damage to the liver itself. For some people NAFLD is not a dangerous condition, but for others it can be. When there is little damage or risk to the liver, the condition is caused non-alcoholic fatty liver (NAFLD).

Causes

People with NAFLD tend to be overweight and also have other related conditions, such as excessively high fats in the blood and type 2 diabetes. It is not clear whether obesity causes NAFLD or whether some other underlying problem leads to excessive weight, problems handling fats and sugar, and the deposits of fat in the liver.

Associated conditions include:

Obesity: Obesity is definitely related to all NAFLD. Obesity is actually determined now not just by how much you weigh but also by what your BMI is. This term means or Body Mass Index. BMI can be calculated in the following way:

Type 2 diabetes mellitus: Type 2 diabetes causes the body to have difficulty handling sugar, both because its cells are resistant to the actions of insulin, which control sugar levels, and because there is a relative lack of insulin in the body. It is associated with other conditions like obesity.

Dyslipidemia: Dyslipidemia is the word for a variety of different types of high fats in the blood. So-called “bad cholesterol” or LDL may be very high in people with NAFLD, as may other fats called triglycerides.

Metabolic syndrome: The metabolic syndrome is a group of these problems associated with obesity, including at least 3 of these:

There are other less-certain associated conditions which a doctor may look for. Older people are more likely to develop NAFLD. Being male and of Hispanic descent increases the chance of having NAFLD.

Symptoms

People with NAFLD usually do not have symptoms.

If NASH is worsening, some people may experience:

A feeling of fatigue and being unwell

A loss of appetite and weight

Abdominal discomfort; pain in the right upper part of the abdomen

If the damage progresses to cirrhosis, there are many serious symptoms and abnormalities that develop due to scarring and failure of the liver. These can be anything from yellowed eyes and skin due to high bilirubin that the liver cannot break down, paleness due to anemia, trouble breathing, bleeding from the esophagus, stomach or rectum, confusion and even coma due to failure of the liver.

Testing and Diagnosis

The diagnosis of NAFLD is frequently made by accident when a person is being examined for another problem. For example, when an ultrasound test is done to look at the gallbladder for gallstones, the liver is also seen. NAFLD has an appearance on ultrasound that can lead to the diagnosis.

Other diagnostic studies such as CT scans or MRIs done to look at the abdomen for various reasons can show fat in the liver and lead to the diagnosis.

If you are at risk of NAFLD, your doctor can screen you by doing a blood testing looking at liver enzymes. There are specific results that might give your doctor a reason to do further tests.

First he or she will do discuss your medical history and your family’s history. Past medical problems might indicate that something could be affecting your liver. You will be asked about alcohol use, intravenous drug use (which can expose you to infectious hepatitis), whether you take any over-the-counter or prescription medications or supplements that contain ingredients that can damage the liver. He or she will ask for your family history and your entire medical history.

Your doctor will then do a physical examination. The most important part is the doctor feeling for the edge of your liver to see if it can be felt, and is soft or hard or lumpy. Your doctor will look at your skin for abnormal color and for specific spots that can appear due to liver disease. He or she will try and tell if fluid is collecting in your abdomen.

Laboratory tests

If there is evidence of a liver problem, your doctor will order further blood tests to find out how serious the problem is and what your diagnosis is. There are a number of specific tests that can indicate if you have an inherited liver problem, an infectious hepatitis, or an autoimmune disease, which happens when your immune system mistakenly attacks parts of your body like the liver.

Imaging studies

As explained above, an ultrasound, which uses sound waves to get a picture of an internal organ, may indicate the presence of NAFLD. It can also be seen on other studies like CT scans and MRIs.

Liver biopsy

This is not needed in every case. The history, examination, blood tests and ultrasound that may have been done will help the doctor decide how likely it is that a person has actual liver damage. If you are not at high risk for NASH, and if there is no evidence of liver damage, a liver biopsy is not recommended at this time.

If there is evidence of liver damage, or if there is a possibility of another serious liver condition, a liver biopsy is needed. The biopsy will be able to tell if there is NASH or any other liver disease. If the damage is severe in enough, scarring of the liver and cirrhosis may be seen.

Treatment

Treatment of the conditions associated with NAFLD frequently may improve the liver abnormalities. That means losing weight, controlling blood sugar, raising good cholesterol levels, lowering bad cholesterol and generally treating all the illnesses that go along with the metabolic syndrome.

People with NASH are at more risk and these lifestyle changes must be made to improve the condition of the liver. A weight loss of 10% may significantly lessen the liver damage.

Those with NAFLD should avoid excessive alcohol consumption or anything else that could further damage the liver. Frequently there is more than one problem in a person with NASH.

Medications

There are almost no specific prescription medications used to treat NAFLD. Treatment of the associated illnesses can include drugs that lower blood sugar and lower bad cholesterol.

The prognosis of NAFLD is good for most people, and the key is to try and prevent progression of liver damage.